HomeMy WebLinkAbout1605 Sheely Dr - Applications/Reroof - 10/13/2014of
F`r# CoWns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 1Iy lcbr-rl Date /a�/-� //
For office use only
Job Site Address (required)
Value 9f Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone 97a,
Ar e-o CG Po5- a, 37i-ca
Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
5ales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: �'Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expblai�n)�
Is this building 5o years of age or more? ❑ Yes A'No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work A*A/ AO-7 61 -*A r- Z
75i S A M . !✓ /atc c �Sx`�o c.+ Q �-r.re Ll S I►. G
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: /�� /��+^/s�'
Print Name: Signature Date
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